Voice Therapy Research Articles

A Case of Tracheogastric Puncture Using Transnasal Esophagoscopy After Total Laryngopharyngoesophagectomy and Gastric Pull-Up Reconstruction

Voice rehabilitation after total laryngopharyngoesophagectomy is a significant challenge, especially when accompanied by gastric pull-up reconstruction. In 2021, a study revealed that tracheoesophageal puncture is also safe and feasible option for voice rehabilitation in patients who underwent gastric pull-up surgery. Here, we report for the first time in South Korea a case that represents an instance of voice prosthesis insertion after gastric pull-up surgery. The case demonstrates the feasibility and safety of voice prosthesis insertion in patients who undergo total laryngopharyngoesophagectomy and gastric pull-up surgery, providing evidence that voice prosthesis insertion is achievable and can be performed in the outpatient setting using transnasal esophagoscopy.

Investigation of Acoustic Voice Characteristics of Individuals Diagnosed with Muscle Tension Dysphonia.

Muscle tension dysphonia (MTD) is a functional voice condition that causes irregular and imbalanced laryngeal and paralaryngeal muscle activation. Our study aimed to examine the acoustic characteristics of patients with MTD and reveal the differences between genders. The study retrospectively reviewed the acoustic examination findings from the files of patients diagnosed with MTD during evaluations in the laryngology outpatient clinic at a tertiary reference hospital between 2015 and 2022. The parameters assessed in prolonged vowel phonation analysis were fundamental frequency (F0), jitter, shimmer, noise-to-harmonic-to-ratio, and soft phonation index; in the counting task analysis, they were intensity, frequency, and semitone. Gender differences in acoustic measurements obtained during prolonged vowel phonation and counting tasks were also examined. The study included 80 individuals diagnosed with MTD. Although all parameters in the acoustic analysis of/a/ phonation were increased, differences were statistically significant only in the F0 and jitter parameters between females and males (p≤0.05). In the analysis of the counting task, the mean and minimum F0 parameters were significantly higher in females than in males (p=0.000). The mean dB level was decreased, particularly in the counting task, but the results for the intensity parameter did not differ significantly between genders (p>0.05). The values in the acoustic voice analysis parameters of patients with MTD were determined. These acoustic parameters are thought to guide the clinician in evaluating voice and determining voice therapy goals for MTD patients.

Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings. Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies. A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.

Relationship between voice impairment and stress coping styles in professionally active teachers.

The cause of voice problems in teachers are excessive voice strain, improper voice emission, and wrong emotional responses to occupational stress. The aim of the study was to analyze the relationship between subjective voice assessment of professionally active teachers treated for voice disorders and their stress-coping styles. The study included 174 female teachers participating in a 24-day voice rehabilitation program at a sanatorium hospital. The Voice Handicap Index (VHI) self-assessment questionnaire was used to subjectively assess voice impairment. The Coping Inventory for Stressful Situations (CISS) questionnaire was used to assess coping styles. The VHI and CISS questionnaires were administered to the teachers at the beginning of the rehabilitation stay. Emotion-focused coping was shown to be associated with the subjective assessment of voice dysfunction as assessed by the VHI questionnaire for the total score and all of its dimensions (p = 0.04). In addition to proper voice emission, the prevention and rehabilitation of occupational voice disorders in teachers should also include stress management techniques, as this can help reduce the incidence of functional voice disorders in this occupational group.

Prevalence of Voice Problems and Associated Risk Factors in Islamic Religious Orators

Islamic leadership is a diverse profession and previous research has highlighted the increased risk of voice problems among Islamic leaders. The prevalence and risk factors for voice problems among Malayalam-speaking Islamic religious orators have not been adequately investigated. This study aimed to assess the prevalence of self-reported voice problems among Islamic religious orators who recite the Adhaan and those who do not and to examine the impact of age and associated risk factors. This study employed a non-experimental research design using survey research. The current findings report a high prevalence of voice problems among Islamic Adhaan reciters and suggest that age-related differences may influence the risk factors associated with voice problems in this population. Only two participants from the older group of Adhaan reciters had received voice therapy, suggesting that the majority of Islamic religious reciters lack knowledge about voice care and voice therapy. A limitation of the study is the lack of otorhinolaryngological examination, particularly laryngoscopy and voice analysis of Islamic religious orators. Further studies can investigate the effect of vocal hygiene training or similar voice management programs on Islamic religious orators' voices.

Analysis of the efficacy of non-surgical treatment mainly focus on voice therapy and it's influencing factors in patients with unilateral vocal fold paralysis

Objective:Retrospective analysis of the efficacy and it's influencing factors of non-surgical treatment mainly focus on voice therapy for patients with unilateral vocal fold paralysis. Methods:The retrospective study includes 57 patients who were diagnosed with unilateral vocal fold paralysis and presented with hoarseness as their main complaint at the Department of Voice Medicine, Zhongshan Hospital of Xiamen University from August, 2021 to August, 2023. Judging the efficacy of non-surgical treatment mainly focus on voice therapy through changes in acoustic, aerodynamic, and laryngoscopic parameters; Analyze the relationship between patients' age, gender, duration of disease, cause of nerve injury, type of nerve injury, side of nerve injury and efficacy of non-surgical treatment. Results:After non-surgical treatment mainly focused on voice therapy, there were statistically significant differences（P<0.01） in the changes of vocal fold bow, glottal gap, glottal compression, loudness, Jitter, Shimmer, IC, and NC parameters. There is a statistically significant correlation between the duration of the disease and changes in glottal gap, Shimmer, and IC（P<0.05）, the side of nerve injury can affect changes of glottal gap and NC（P<0.05）. Conclusion:Non-surgical treatment mainly focused on voice therapy has a good efficacy on patients with unilateral vocal fold paralysis. The duration of the disease and the side of nerve injury may affect the efficacy.

Clinical Effects of Voice Therapy on Vocal Outcomes in Unilateral Vocal Fold Paralysis: Proof-of-Concept Study for Two SOVT-Based Treatment Protocols

BackgroundStudies on treatment efficacy in unilateral vocal fold paralysis (UVFP) often lack a predetermined treatment protocol, and little is known about the effects of specific vocal techniques on vocal outcomes and quality of life in UVFP patients. The purpose of this preliminary proof of concept study is to investigate the effects and feasibility of two intensive treatment protocols based on water-resistance therapy (WRT) and vocal function exercises (VFE). MethodsTen participants with acute or chronic UVFP/paresis were recruited in the study and randomly assigned to the WRT or VFE group. Three of these participants presented with aphonia and could not complete the program as prescribed. The remaining participants completed an intensive therapy program with the assigned vocal technique. Before, during, and after the program, a multidimensional voice assessment was performed. Maximum phonation time, acoustic, perceptual, and patient-reported outcome measures were obtained. ResultsWRT and VFE had positive clinical effects on instrumental and auditory-perceptual voice quality, glottal closure, and patient-reported outcome measures, but inter-individual variability was high. Studies with larger sample sizes are necessary to confirm or refute these findings. ConclusionThe WRT- and VFE-based therapy programs are both feasible and seem to elicit positive clinical changes in UVFP patients. Suggestions on how to improve the programs are provided, as well as considerations for implementation in clinical practice. Follow-up research is needed to examine the efficacy of both programs on group level.

Comparison of Vocal Amplitude and Contact Speed according to SOVTE Type

Objectives: Observation of vocal fold vibration during semi-occluded vocal tract exercises (SOVTE) can help in understanding voice production due to semi-occlusion. This study aimed to investigate the differences in vocal fold vibration characteristics among various types of SOVTE. This study may provide valuable evidence to support more specific and effective methods in applying SOVTE to voice therapy. Methods: A total of 10 healthy young adults (5 males, 5 females) with a mean age of 24.28±4.54 years participated in the study. None of the participants had any voice-related diseases or were smokers. The participants performed various types of SOVTE including humming, voiced bilabial fricative, straw phonation, and water-resistance straw phonation. The authors measured the amplitude and contact speed of vocal fold using a vibration simulator and digital kymography (DKG). Results: The results showed that vocal fold amplitude was not significantly different among types of SOVTE, but there were significant differences in vocal fold contact speed (&lt;i&gt;p&lt;/i&gt;=.046). In multiple comparisons, vocal fold contact speed was significantly faster in humming (&lt;i&gt;p&lt;/i&gt;=.031) and water-resistance straw phonation (&lt;i&gt;p&lt;/i&gt;=.018) compared to straw phonation. Conclusion: The difference in vocal fold contact speed indicates that the vocal fold vibration during SOVTE is affected by the shape of the vocal tract. The use of humming and water-resistance straw phonation can be an effective approach to improve voice quality by increasing vocal fold contact speed, which is a key factor in determining overall voice quality. These two methods can be useful in voice therapy after laryngeal microsurgery. In the field, conducting trial therapy rather than applying voice therapy according to the hierarchy of SOVTE may lead to successful results. SD children articulate phoneme sequences more segmentally in unlearned nonword contexts.

The ethics of performance care: A pragmatic feminist analysis of policy for singing voice rehabilitation.

This paper uses pragmatic feminist poststructuralism to explore how ethical theory is applied to singing voice rehabilitation by specialist singing teachers. A critical literature review examines the relationship between traditional and feminist ethical theories and their potential impact on practice. Themes have been extracted from the literature to create an intersectional feminist poststructural analysis framework, facilitating a document analysis of the foundations of three policy documents currently available to singing voice rehabilitation specialists. Poststructural deconstructivism was applied to thematic analysis to consider the impact of ethical theories on policy and practice. Policies we found to be rooted in traditional enlightenment ethics, with a focus on hyper-rationality, androcentrism and legalism. Person-centred care ethics was found to be lacking in all documents. Contrary to best-practice recommendations documents failed to provided practical guidelines for practitioners. Findings indicate adopting an intersectional feminist ethical policy could improve existing documents via a move from legislation and authority towards care and reflexivity.

Comparison of voice quality in patients with oral cancer at both pre and post treatment stage

Background: Patients with oral cancer have very common complaints of change in voice. This research is designed to study the effect of oral cancer and its treatment on the various domains of voice like functional, physical, and emotional along with parameters of voice like pitch, loudness and quality. Method: This study included total 48 participants (34 males and 14 females) with oral cancer. The voice quality of the participants was analysed both before and after treatment using Dr. speech and the voice handicap index (VHI). First, the voice analysis done when the patient was diagnosed as a case of oral cancer by the head-neck oncosurgeon after completion of all required investigations. Patients were recalled for voice analysis after completion of treatment. Results: There was a significant difference observed in all three domains of the VHI at both before and after treatment. The difference in the functional domain was more prominent. The VHI was not linked to tumor or nodal staging. However, post treatment the voice parameters are greatly affected as compared to pre-treatment stage. Conclusions: The administration of the VHI should be made mandatory prior to treatment of oral cancer and the findings of the test should be discussed with the patient prior to start of any treatment modality and accordingly the realistic expectations can be set. Therefore, voice analysis using Dr speech will also help in timely assessment and rehabilitation of voice before and after treatment.

Revisiting the etiology and clinical characteristics of hemorrhagic polyps of the vocal fold.

Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level 3: Retrospective cohort study.

The Impact of Timing of Voice Therapy in the Vocal Outcomes of Surgically Treated Benign Vocal Fold Lesion Patients

The Impact of Timing of Voice Therapy in the Vocal Outcomes of Surgically Treated Benign Vocal Fold Lesion Patients

Vocal Fold Pseudocysts: Are Unilateral and Bilateral Lesions Distinct Entities?

Unilateral vocal fold pseudocysts have been hypothesized to result from vocal fold paresis, but no explanation has been proposed for bilateral lesions. This study compares patients with unilateral to those with bilateral pseudocysts for insights into pathogenesis. Adults with unilateral and bilateral pseudocysts evaluated between 2018 and 2023 were retrospectively studied. Patient demographics, laryngeal stroboscopic findings, management strategies employed, and treatment outcomes were recorded. Fisher's exact and student's t-tests were performed to assess unilateral and bilateral cohorts for differences. One hundred ninety-six patients (109 with bilateral and 87 with unilateral pseudocysts) were studied. The average age was 29 years (bilateral: 29 years, unilateral: 30 years; p = 0.3846). The groups differed with respect to sex (172 females: 105 bilateral, 67 unilateral; 24 males: 4 bilateral, 20 unilateral; p < 0.0001) and clinical diagnosis of paresis (bilateral: 13.8%, unilateral: 34.5%; p = 0.0010). Treatment was similar between cohorts for rates of voice therapy (bilateral: 67.0%, unilateral 63.2%; p = 0.6511) and surgery (bilateral: 12.8%, unilateral 17.2%; p = 0.4228). There were a total of six recurrences (bilateral: 2, unilateral: 4; p = 0.3898). Bilateral pseudocysts occur almost exclusively in women and with a relative absence of paresis. Unilateral pseudocysts are more likely to occur in the presence of paresis and in a significantly higher proportion of men. This suggests that unilateral and bilateral disease evolve in different clinical conditions, although they may share glottic insufficiency as a predisposing factor. III Laryngoscope, 2024.

Patient Motivation for Voice Therapy Increases After Stimulability Testing: Validation of a Voice Therapy Motivation and Voice Perception Inventory.

Measuring patient motivation for voice therapy is an important component of determining prognosis and estimating compliance. Voice stimulability testing is assumed to influence the patient's motivation by improving their perception of the sound and/or feel of the voice. The purpose of this study was to validate a Voice Therapy Motivation and Voice Perception Inventory and to determine whether stimulability testing elicits improvements in motivation and patient-perceived voice status. Seventy-five patients who underwent initial voice therapy evaluation completed a four-item inventory that queried their commitment to voice therapy, confidence that they could change their voice through voice therapy, perception of their voice severity, and ratings of their vocal effort. Inventories were completed shortly before and after stimulability testing. A psychometric analysis of the survey was conducted, including the internal consistency of each construct of the inventory along with content, predictive, and concurrent validity. Paired-samples statistical analyses were conducted to determine differences before and after stimulability testing, and Spearman correlations between voice and motivation ratings were conducted to determine relationships between the patient's perception of their voice and their motivation for voice therapy. Internal consistency reliability was acceptable to good for each construct, particularly after stimulability testing. Motivation scales were predictive of returning for voice therapy sessions, subjective improvement of voice by the first therapy session, and likelihood of the patient practicing the home practice program. Patient ratings of voice severity and effort were positively correlated with clinician ratings of overall severity. Motivation and voice impairment perception improved following stimulability testing. Reduction in vocal effort was related to improved motivation, but change in voice severity was not. Voice stimulability testing can influence patient motivation for voice therapy and patient-perceived voice improvements. It should be considered a critical part of the voice evaluation.

Exploring autonomic dysfunction in functional dysphonia: A protocol for a case-control study and a randomized controlled trial.

Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). Case-control study: Autonomic (dys)function of patients with FD will becompared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will beperformed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. What is already known on the subject Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.

Acoustic, aerodynamic, and vibrational effects of ventricular folds adduction in an ex vivo experiment.

The excessive adduction of ventricular folds has been observed in patients with dysphonia and professional singers. Whether these changes in the ventricular folds are the cause or just a result of disease progression remains unclear, and their potential pathological and physiological implications are yet to be determined. This study aimed to examine the impact of different degrees of ventricular adduction on acoustics, aerodynamics, and vocal fold vibration. The excised models of mild and severe ventricular adduction were established. We recorded the vibration pattern of vocal folds and ventricular folds and measured acoustic metrics, including fundamental frequency (F0), Jitter, Shimmer, harmonic-to-noise ratio (HNR), and sound pressure level (SPL). Furthermore, we evaluated the aerodynamics index through phonation threshold pressure (PTP), phonation instability pressure (PIP), mean flow rate (MFR), phonation threshold flow (PTF), and phonation instability flow (PIF). Irregular vibrations of the ventricular fold were observed during ventricular adduction. Notably, mild and severe ventricular adduction conditions showed a significant increase in PTP, Shimmer, and Jitter, whereas MFR, PIF, and HNR decreased compared with the control condition. Ventricular adduction leads to the deterioration of acoustic and aerodynamic parameters. The aperiodic and irregular vibration of the ventricular folds may be responsible for this phenomenon, although further experiments are warranted. Understanding the functioning of ventricular folds can be beneficial in directing the treatment of muscle tension dysphonia and improving voice training techniques.Level of evidence: level 4.

Effectiveness of Voice Therapy in Telepractice with Patients with Hyperfunctional Voice Disorder: A Pilot Study.

Background: The need for telepractice and digital treatment has increased due to issues this revision.regarding medical access and the COVID-19 pandemic. However, in many countries, telepractice is rarely performed. The purpose of this pilot study was to describe the detailed process of telepractice in patients with hyperfunctional voice disorder and investigate its effects. Methods: The three subjects who were enrolled in this pilot study had hyperfunctional voice disorders. The evaluation was performed face to face. Auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, patient self-evaluation, and interviews were conducted. Treatment was delivered by telepractice using a smartphone application. Results: In quantitative analysis of auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, and patient self-evaluation, all subjects showed improved voice after treatment. In-depth analysis of telepractice was performed through the interview. Conclusions: Telepractice was effective in patients with voice disorders, and the patients were satisfied with this approach. In addition to this pilot study, further large-scale studies are required, but telemedicine may improve treatment outcomes and patient satisfaction in cases where medical access is limited or during outbreaks of respiratory infections like COVID-19.

Voice Rehabilitation after tongue cancer surgery: a cohort study in indian population

Voice Rehabilitation after tongue cancer surgery: a cohort study in indian population

The efficacy of voice therapy for Bangladeshi patients with vocal fold nodules

Voice therapy in improving the voice quality of vocal fold nodule patientshas evidentiary support. This study aimed to investigate the efficacy of voicetherapy for Bangladeshi patients (N=30) with vocal fold nodules, as well as thefactors (therapy practice and maintenance of vocal hygiene) that influence theeffectiveness or outcome of voice therapy in treating vocal fold nodules. This studywas an observational cohort study of 30 Bangladeshi adult patients with vocalfold nodules (mean age=41; SD= 8.78). Before and after voice therapy, Phonationexercises and narrative-telling tasks were used to elicit voice features, and the sizeof vocal fold nodules was observed through Fiber Optic Laryngoscopy (FOL). Thedata was statistically analyzed using the percentage/proportion test and Fisher’sexact test to demonstrate the success of voice therapy and the factors impactingthe therapy’s efficacy. The findings indicated that voice therapy was successfulfor most participants (87%). Practicing therapy regularly and maintaining vocalhygiene had an impact on therapy success.

Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol

BackgroundThe intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. ObjectiveTo design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) invoice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. MethodsA descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. ResultsThe developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient (CVC) exceeding 0.90 for most items, indicating high consensus on the protocol’s relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. ConclusionWe present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.